Healthcare Provider Details

I. General information

NPI: 1114150968
Provider Name (Legal Business Name): SIMPSON & BIGHAM OD PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 W FRANKLIN ST
EVANSVILLE IN
47712-5564
US

IV. Provider business mailing address

2417 W FRANKLIN ST
EVANSVILLE IN
47712-5564
US

V. Phone/Fax

Practice location:
  • Phone: 812-423-5000
  • Fax: 812-423-6838
Mailing address:
  • Phone: 812-423-5000
  • Fax: 812-423-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003226
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002839
License Number StateIN

VIII. Authorized Official

Name: AMY L GORMAN-MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 812-423-5000